• Mingyang Li, Rong Luo, Yi Zeng, Yuangang Wu, Yuan Liu, Limin Wu, and Bin Shen.
• Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Guoxue Road, 610041, Chengdu, Sichuan, People's Republic of China.
• Arch Orthop Trauma Surg. 2022 Jun 1; 142 (6): 1167-1176.

BackgroundPublished studies have reported many inconsistent results regarding the comparison of same-day discharge total joint arthroplasty (TJA) and inpatient TJA. More notably, many recent studies comparing same-day discharge TJA with fast-track TJA presented higher rates of complications for same-day discharge TJA, which raises concerns about the safety of same-day discharge TJA.MethodsWe systematically searched the MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases up to June 2020 for studies comparing mortality, readmission, and complications in same-day discharge and inpatient total hip or knee arthroplasty. Studies that used inpatient TJA as the control could be further divided into fast-track inpatient TJA (length of stay [LOS] ≤ 2 days) and traditional inpatient TJA (no restrictions on LOS). Relative risks were pooled to compare the outcomes of the same-day discharge group and the control group.ResultsAccording to selection criteria and quality assessment, 14 studies including 222,766 cases were identified. There was no significant difference in the risk of mortality (RR = 1.42, CI [0.67, 3.01]) or readmission (RR = 0.93, CI [0.79, 1.10]) between same-day discharge TJA and inpatient TJA. Compared with fast-track TJA, the rate of overall complications in same-day discharge TJA was significantly higher (RR = 1.67, CI [1.45, 1.93]), while the rates of overall complications were similar between same-day discharge and traditional inpatient TJA (RR = 0.83, CI [0.67, 1.03]).ConclusionThe overall safety of same-day discharge TJA is satisfactory; however, more complications were detected in same-day discharge TJA than that in fast-track TJA. Complications in same-day discharge TJA might be underestimated in some previous studies taking long-staying inpatient TJA as control. Being more cautious about complications is necessary in the care of same-day discharge TJA, and extensive prospective studies are needed to explore the optimized option that weighs both cost and complications.© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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